Posttraumatic stress disorder

Overview

What is PTSD?

Most people are likely to experience a potentially traumatic event in their lifetime, and most individuals recover well, given time and adequate social support.1 For some individuals however, the experience of a traumatic event or chronic exposure to trauma can trigger symptoms of posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD) refers to a set of symptoms that can emerge following the experience of a traumatic event that involves exposure to actual or threatened death, serious injury, or sexual violence. Exposure to such events can be through:

directly experiencing the traumatic event

witnessing, in person, the event happening to someone else

learning that the event has happened to a close family member or close friend

repeated or extreme exposure to the aftermath of trauma (e.g. first responders to emergency situations).

Symptoms are characterised by a sense of reliving of the traumatic event, avoidance of reminders of the traumatic event, feeling numb, having negative thoughts and mood, and feeling agitated or wound up.2

Without treatment, PTSD can become a chronic condition, and places the individual at greater risk of developing other mental health problems, such as depression or anxiety, or problems with alcohol or drug use.3 With sound psychological intervention however, the chances of recovery are good.4

Signs and symptoms

Symptoms are characterised by:2, 5

A sense of reliving the traumatic event

experiencing unwanted and distressing thoughts or images, flashbacks, nightmares, or feeling as though the event is recurring.

Avoidance and numbing

avoidance of people, places, thoughts and activities associated with the traumatic event

A diagnosis of PTSD is made when these symptoms are present for more than one month and cause significant distress, or interfere with important areas of functioning, such as work, study, or family life.2

What causes PTSD?

Whilst traumatic events are the trigger for PTSD, not everyone who experiences a traumatic event goes on to develop PTSD. Research looking at factors related to the causes of PTSD has revealed several explanations for how the disorder develops.2

Biological models - The stress response, by nature, is physiological, and the core symptoms of PTSD such as agitation, a heightened startle response, and memory disturbances, have a basis in how the brain processes and responds to stress. Differences in the sympathetic nervous system, which controls stress hormones such as adrenalin, as well as brain circuitry related to anxiety responses, may differ between individuals with and without PTSD.6-8

Psychological models – In PTSD, previously neutral objects, places, people, sounds and smells can become associated with a traumatic event, and trigger the fear response even in the absence of danger. This association between benign stimuli and a fear response has been found to be the basis for many PTSD symptoms.9

Information processing and memory models - It has been suggested that high stress and arousal at the time of the trauma impacts on the way in which traumatic information is encoded in memory, which may underlie the physical symptoms of PTSD and the experience of ‘reliving’ the event.10-14

Other risk factors include:15

the type and severity of the trauma - sexual assault and abuse, military combat, and terrorist acts are linked to a higher rate of PTSD than motor vehicle accidents and natural disasters3, 16, 17

lack of social support

subsequent life stress.

Evidence-based psychological interventions

There are a range of psychological treatments for adults with PTSD. The two types of treatment that are most effective are called trauma-focused cognitive behaviour therapy (TF-CBT) and eye movement desensitisation and reprocessing (EMDR).4

Trauma-focused Cognitive Behaviour Therapy (TF-CBT)

In Trauma-focused Cognitive Behaviour Therapy (TF-CBT) the psychologist helps the person to confront memories and reminders of the trauma, change the way they think and feel about the traumatic experience, and find more helpful ways of coping, through exposure therapy and cognitive therapy techniques. In imaginal exposure therapy the person is supported to gradually confront their memories of the trauma, whilst within in vivo exposure therapy the person is supported to gradually confront safe situational reminders of the trauma that are otherwise avoided. Repeated imaginal and in vivo exposure, has been found to be highly effective.18, 19

EMDR

EMDR is based on the idea that overwhelming emotions during a traumatic event interfere with normal information processing, resulting in flashbacks, nightmares, and other distressing symptoms. In EMDR, the person is asked to focus on particular images, thoughts, and bodily sensations related to the traumatic event while moving their eyes back and forth across their field of vision, tracking the movement of the therapist’s finger. It is proposed that the dual attention helps the individual to process the trauma and integrate the memory with existing memory networks.20

Social and behavioural interventions

Social support after a trauma has been found to be the best predictor of recovery.21 As such, treatment for PTSD is likely to involve building or strengthening the person’s social support network.

Some lifestyle changes might also be helpful, such as reducing or eliminating the use of alcohol or drugs which can increase certain PTSD symptoms and slow recovery.22-24

Relaxation exercises can help reduce feelings of agitation and being on edge25, 26 whilst maintaining a balanced diet and engaging in routine exercise supports general emotional and physical wellbeing which can also aid recovery.27-29

How a psychologist can help

Through discussion with the client and the possible use of questionnaires and monitoring tools, the psychologist develops an understanding of the potential factors involved in the onset and maintenance of the individual’s symptoms. A treatment plan is then developed by the psychologist together with the individual, drawing on evidence-based treatments for PTSD and an understanding of the client’s specific needs.

The psychologist may also assist their client to address any lifestyle factors which may be getting in the way of their capacity to manage their difficulties, and reduce symptoms of PTSD. They may also suggest involving a supportive family member or friend to assist in the understanding of the individual’s situation and to support treatment.

Other professionals who may be involved

A medical review with a GP or another mental health specialist such as a psychiatrist may be suggested to determine whether another condition could account for the individual’s symptoms. Trauma-focused CBT or EMDR are usually the best treatments for PTSD, but medication can sometimes help the recovery process.30 A GP or psychiatrist would oversee this aspect of the individual’s treatment. A social worker or another community-based professional may also help to manage housing or social needs that have arisen as a result of a traumatic event. Other health specialists might be involved in rehabilitation if a physical injury has occurred.

When to seek professional help

If the distress associated with a traumatic event has been affecting a person’s work, school, or home life for more than two weeks, psychological assistance should be considered. The APS Find a Psychologist service can be used to locate a psychologist in your local area: call 1800 333 497 or visit www.findapsychologist.org.au. A GP can also organise a referral to an APS psychologist under the Better Access to Mental Health Care items.

More information

Australian Psychological SocietyAustralia’s largest professional association for psychologistswww.psychology.org.au

Australian Centre for Posttraumatic Mental HealthInformation about the impact of trauma and treatment for PTSDwww.acpmh.unimelb.edu.au

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